Provider Demographics
NPI:1912698614
Name:DECKER, BRIAN (AUD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DECKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 OLD CHAIN BRIDGE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3945
Mailing Address - Country:US
Mailing Address - Phone:703-942-8110
Mailing Address - Fax:703-942-8042
Practice Address - Street 1:818 W DIAMOND AVE STE 120
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1450
Practice Address - Country:US
Practice Address - Phone:301-963-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01643237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter